Kotatee Tamba, LP, LICSW

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP7120 Issued in MN

Practice address

2500 2ND St NE Apt 607
Minneapolis, MN 55418-3588

Phone

(651) 497-9483

NPI assigned

May 5, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Catalyst Mental Health, GBCGroup PAC ID 1355500752, 29 clinicians

Midwest Recovery, IncGroup PAC ID 3476076712, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Midwest Recovery, Inc

  • Substance Abuse Rehabilitation Facility
  • Bloomington, MN
  • NPI 1801268354
  Medicare reassignment Care Compare group NPD
• Catalyst Mental Health, GBC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Minneapolis, MN
  • NPI 1134490147
  Medicare reassignment Care Compare group
• Fernbrook Family Center

  • Social Worker
  • Red Wing, MN
  • NPI 1437427911
  NPD (past)
• Fernbrook Family Center, Inc

  • Social Worker
  • Owatonna, MN
  • NPI 1659483915
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1399248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1366852972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 977",
            "city": "OWATONNA",
            "state": "MN",
            "postal_code": "550600977",
            "telephone_number": "507-446-0431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 2ND ST NE APT 607",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554183588",
            "telephone_number": "651-497-9483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAMBA",
        "first_name": "KOTATEE",
        "credential": "LP, LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-05",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "21317",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP7120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Robert Talsness, DO
• Gershom Aaron Tam, NP
• Victor Tam, PHARMD
• Tamarack Counseling & Consulting LLC
• Tamay Home Healthcare LLC
• Maurine Kyo Tambi Tufon, REGISTERED NURSE
• Rabindra R Tambyraja, M.D.
• Ashenafi Mekonnen Tamene, M.D.
• Rahul Tamhane, MD
• Kalkidan Tamiru

• Psychologist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.